| NPI | 1922545581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11048684) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM 76178) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 12-197) | |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2026-07-10 |