| NPI | 1689184657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 826045) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN207430) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NV 826045) | |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2025-05-28 |