| NPI | 1225730195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 71708) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 4036015) |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 14997) | |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2025-07-03 |