| NPI | 1780406579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP005035) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-201079) |
| Enumeration Date | 2024-10-31 |
| Last Update Date | 2026-05-29 |