| NPI | 1013744820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11042165) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: PR 2757) |
| 163W00000X Registered Nurse (Licence: PR 85590) | |
| Enumeration Date | 2024-09-16 |
| Last Update Date | 2025-09-14 |