| NPI | 1821889585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 324485) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 324485) |
| 207R00000X Internal Medicine (Licence: AZ 324485) | |
| Enumeration Date | 2025-05-13 |
| Last Update Date | 2025-08-12 |