| NPI | 1275376451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11040702) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9531134) |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2025-08-13 |