| NPI | 1063273894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP004223) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: AL 1-156340) |
| Enumeration Date | 2024-01-18 |
| Last Update Date | 2025-11-20 |