| NPI | 1669930145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-123271) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11042154) |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2026-02-09 |