| NPI | 1487230983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 56025) |
| Additional Taxonomies | 163WP1700X Registered Nurse, Perinatal (Licence: ID 56025) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2025-04-30 |