| NPI | 1801511936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 8871953) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID 58053) |
| Enumeration Date | 2022-10-11 |
| Last Update Date | 2025-09-19 |