| NPI | 1396517157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11030325) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 14573-33) |
| Enumeration Date | 2023-10-25 |
| Last Update Date | 2024-09-25 |