| NPI | 1134380678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5023326) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 3572) |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 3572) | |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2025-10-29 |