| NPI | 1699273839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR A005503) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR ATP-001246) |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2025-10-23 |