| NPI | 1134096399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11043548) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11043548) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 22-161) | |
| Enumeration Date | 2025-10-22 |
| Last Update Date | 2026-08-31 |