| NPI | 1447943378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP003712) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-168891) |
| Enumeration Date | 2023-05-26 |
| Last Update Date | 2025-09-18 |