| NPI | 1386527562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 892442) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NV 892442) |
| Enumeration Date | 2025-07-28 |
| Last Update Date | 2026-01-13 |