| NPI | 1700629227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-141246) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-141246) |
| Enumeration Date | 2024-06-13 |
| Last Update Date | 2025-04-16 |