| NPI | 1750982856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11046381) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 11046381) |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2026-05-01 |