| NPI | 1699244335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 22390) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11039187) |
| Enumeration Date | 2018-11-23 |
| Last Update Date | 2025-11-10 |