| NPI | 1285443150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL 11037113) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9595680) |
| Enumeration Date | 2025-01-04 |
| Last Update Date | 2025-05-26 |