| NPI | 1821734054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11044086) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9599858) |
| 163W00000X Registered Nurse (Licence: NY 832394) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 358179) | |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2025-12-10 |