| NPI | 1891559357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 237777) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11025277) |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2025-04-16 |