| NPI | 1447114327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A188397) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.034353) |
| Enumeration Date | 2025-12-15 |
| Last Update Date | 2026-02-13 |