| NPI | 1013626365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP11024290) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 350583) |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2025-10-31 |