| NPI | 1003660945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 15422) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: WI 248849-30) |
| Enumeration Date | 2024-04-16 |
| Last Update Date | 2024-08-02 |