| NPI | 1568206290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11046806) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9651018) |
| Enumeration Date | 2024-06-19 |
| Last Update Date | 2026-04-15 |