| NPI | 1891656096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11041834) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11041834) |
| Enumeration Date | 2025-11-19 |
| Last Update Date | 2026-03-27 |