| NPI | 1861222481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 13024) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11033282) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2025-09-12 |