| NPI | 1225051345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 253) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 82771) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2025-09-11 |