| NPI | 1427480201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WY 56549) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID GNP-25968) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2026-02-23 |