| NPI | 1487479325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 239268) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR 215785) |
| Enumeration Date | 2024-11-16 |
| Last Update Date | 2025-01-15 |