| NPI | 1083503130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL 9520004) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11035827) |
| Enumeration Date | 2025-07-02 |
| Last Update Date | 2025-07-02 |