| NPI | 1558092221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 31902) |
| Additional Taxonomies | 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: FL APRN11019284) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 352020) | |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2026-09-08 |