| NPI | 1902625189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11035706) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 11035706) |
| Enumeration Date | 2024-10-07 |
| Last Update Date | 2025-03-14 |