| NPI | 1619853298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11043262) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9643106) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11043262) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11043262) | |
| Enumeration Date | 2025-08-11 |
| Last Update Date | 2026-05-15 |