| NPI | 1538973615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10041641) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: NC 354139) |
| Enumeration Date | 2025-02-06 |
| Last Update Date | 2025-11-20 |