| NPI | 1558015644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11027472) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9387120) |
| 363L00000X Nurse Practitioner (Licence: FL APRN11027472) | |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2024-06-12 |