| NPI | 1730998063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11046046) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9652617) |
| 163W00000X Registered Nurse (Licence: NY 926562) | |
| Enumeration Date | 2025-01-02 |
| Last Update Date | 2026-03-12 |