| NPI | 1164086336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: HI 5296) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: HI 87570) |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2025-07-01 |