| NPI | 1043975105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11025309) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11025309) |
| 163W00000X Registered Nurse (Licence: FL RN9544203) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 2023208786) | |
| 363L00000X Nurse Practitioner (Licence: FL F03230441) | |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: FL 2340260062) | |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2025-09-07 |