| NPI | 1235874314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 84703) |
| Additional Taxonomies | 363LW0102X Nurse Practitioner, Women's Health (Licence: NM 84703) |
| Enumeration Date | 2022-05-03 |
| Last Update Date | 2025-09-22 |