| NPI | 1851860142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9394253) |
| Enumeration Date | 2018-11-16 |
| Last Update Date | 2026-04-30 |