| NPI | 1396508156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 11030226) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11030226) |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2024-06-20 |