| NPI | 1649872334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11010456) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9434475) |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2025-10-29 |