| NPI | 1902325699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 214486) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA AP09467) |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2025-04-01 |