| NPI | 1831778174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AR 215186) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR 1942360052) |
| 207Q00000X Family Medicine (Licence: AR 215186) | |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2025-06-09 |