| NPI | 1487398608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP025646) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA SP025646) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2026-01-27 |