| NPI | 1932937711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 237558) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA LA107769) |
| Enumeration Date | 2024-07-23 |
| Last Update Date | 2026-02-06 |