| NPI | 1699418483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11028542) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9530854) |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2023-10-24 |