| NPI | 1245948066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 28296) |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2024-12-20 |