| NPI | 1730900572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PR 5649) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11036168) |
| Enumeration Date | 2024-10-23 |
| Last Update Date | 2025-03-26 |