| NPI | 1730445586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 19378) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-109738) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2026-06-02 |