Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
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NPI 1962738690

Individual provider · NPI 1962738690 Deactivated

This NPI was deactivated on October 22, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1962738690 is listed in the national NPI registry.

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Record details

NPI number1962738690
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—