| NPI | 1548669823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E19988) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AR A004186) |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2025-10-28 |