| NPI | 1144839481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL 11042274) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9564919) |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2025-09-17 |