| NPI | 1932504990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NE 115541) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001572) |
| Enumeration Date | 2014-11-01 |
| Last Update Date | 2025-02-18 |