| NPI | 1922580869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 9442363) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9442363) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 9442363) | |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2026-03-17 |