| NPI | 1477251007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MD AC006609) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: IA A173353) |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2025-04-01 |