| NPI | 1083215735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 251902) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11010075) |
| Enumeration Date | 2020-11-07 |
| Last Update Date | 2025-12-05 |