| NPI | 1164129318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: ID 6971173) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID 7971173) |
| Enumeration Date | 2023-02-08 |
| Last Update Date | 2026-06-23 |