| NPI | 1710587878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006771) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9312352) |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2026-05-14 |