| NPI | 1144004904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 12050251-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID 73527) |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2026-03-29 |