| NPI | 1497782510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11022289) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11022289) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL APRN11022289) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2025-12-01 |