| NPI | 1184269532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2019035277) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: MO 2019035277) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: KS 53-84352-122) | |
| Enumeration Date | 2019-11-08 |
| Last Update Date | 2026-08-18 |