| NPI | 1316547292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PR 004376) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11008028) |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2025-06-12 |