| NPI | 1609003318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL ARNP9265567) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9265567) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2026-02-13 |