| NPI | 1730662149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 261720) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 261720) |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2026-04-09 |