| NPI | 1235812124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-178678) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11036852) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209032819) | |
| 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP001538) | |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2026-05-29 |