| NPI | 1982830428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11008511) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9360573) |
| 163W00000X Registered Nurse (Licence: NY 614042) | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2025-07-28 |