| NPI | 1093224347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 118625-23) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9654074) |
| 363L00000X Nurse Practitioner (Licence: AZ 8591) | |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 17-460) | |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2026-08-08 |