| NPI | 1134974538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: GA GAA-NP004232) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 242649) |
| Enumeration Date | 2024-04-19 |
| Last Update Date | 2025-11-24 |