| NPI | 1417787821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1214260) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN1031400) |
| Enumeration Date | 2024-08-02 |
| Last Update Date | 2026-03-24 |