| NPI | 1124845938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11040859) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9440514) |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2025-08-16 |