| NPI | 1942803861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11022369) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9372941) |
| Enumeration Date | 2020-11-21 |
| Last Update Date | 2022-11-06 |