| NPI | 1841675436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS 901721) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-194292) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA NP95002747) | |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2025-04-28 |