| NPI | 1588428288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 29779) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 29779) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-02-13 |
| Last Update Date | 2026-02-13 |