Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
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NPI 1902741978

Individual provider · NPI 1902741978 Deactivated

This NPI was deactivated on October 26, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1902741978 is listed in the national NPI registry.

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Record details

NPI number1902741978
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—