| NPI | 1881466134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11043480) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9513687) |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2026-01-21 |