| NPI | 1447115076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11045161) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL RN9484004) |
| Enumeration Date | 2025-12-16 |
| Last Update Date | 2026-01-30 |