| NPI | 1992426134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5019525) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5019525) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2026-05-21 |