| NPI | 1952094856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11026919) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9504106) |
| Enumeration Date | 2023-05-29 |
| Last Update Date | 2026-01-29 |