| NPI | 1548049562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11028836) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11028836) |
| Enumeration Date | 2023-09-28 |
| Last Update Date | 2026-04-04 |