| NPI | 1922407063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5011826) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP7739) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2025-03-27 |