| NPI | 1801205588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9279507) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL ARNP9279507) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2026-04-15 |