| NPI | 1245900398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021037375) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 227968) |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2026-05-21 |