| NPI | 1538528492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NH 084390-23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 084390-23) |
| Enumeration Date | 2016-02-19 |
| Last Update Date | 2025-08-27 |