| NPI | 1215388160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL RN135083) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-154991) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2025-07-07 |