| NPI | 1023848470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 29205) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: SC 217083) |
| Enumeration Date | 2024-08-01 |
| Last Update Date | 2024-08-27 |