| NPI | 1932906526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5021896) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 236128) |
| Enumeration Date | 2025-02-28 |
| Last Update Date | 2026-04-16 |