| NPI | 1154846442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021013225) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP9367810) |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2026-05-14 |