| NPI | 1033815774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 84589) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM RN-75937) |
| 163W00000X Registered Nurse (Licence: NM RN75937) | |
| Enumeration Date | 2023-02-03 |
| Last Update Date | 2025-06-23 |