| NPI | 1912750597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11032235) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11032235) |
| Enumeration Date | 2024-04-11 |
| Last Update Date | 2025-05-08 |