| NPI | 1669212387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 28720) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 28720) |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2025-03-06 |