| NPI | 1801682240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 29858) |
| Additional Taxonomies | 363LX0106X Nurse Practitioner, Occupational Health (Licence: SC 29858) |
| Enumeration Date | 2025-04-15 |
| Last Update Date | 2025-09-30 |