| NPI | 1467152678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN11024752) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: FL 11024752) |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2025-04-29 |