| NPI | 1326867508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 317451) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 10634634-4405) |
| Enumeration Date | 2024-10-07 |
| Last Update Date | 2025-01-29 |