| NPI | 1831987817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 92059) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM RN-78855) |
| Enumeration Date | 2025-04-29 |
| Last Update Date | 2026-09-27 |