| NPI | 1770479099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 347000-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 347000-3102) |
| Enumeration Date | 2025-06-13 |
| Last Update Date | 2025-11-10 |