| NPI | 1346317856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 3107812) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95023558) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2026-01-10 |