| NPI | 1518693712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11020915) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL 11020915) |
| Enumeration Date | 2022-07-28 |
| Last Update Date | 2026-01-21 |