| NPI | 1942789367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP11637) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ TAP11637) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2026-03-20 |