| NPI | 1013717461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 203951) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 113386-23) |
| Enumeration Date | 2025-03-14 |
| Last Update Date | 2025-03-14 |