| NPI | 1114538642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 25836) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11001929) |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2025-06-28 |