| NPI | 1669187548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61395684) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95034813) |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 86832) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15571600) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY F357288-01) | |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2026-06-10 |