| NPI | 1689285538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 24112) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN216844) |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2025-12-30 |