| NPI | 1427583616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA NP270279) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95006222) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2025-12-03 |