| NPI | 1174397194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 15670-33) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: WI 164543-30) |
| Enumeration Date | 2023-11-09 |
| Last Update Date | 2025-05-07 |