| NPI | 1639825979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 27729) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC 27729) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2022004331) | |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2025-12-05 |