| NPI | 1205722436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 31763) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: SC 256733) |
| Enumeration Date | 2025-06-16 |
| Last Update Date | 2026-08-21 |