| NPI | 1891625240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11049169) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9511859) |
| Enumeration Date | 2026-05-19 |
| Last Update Date | 2026-07-17 |