| NPI | 1306729512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 328949) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9513392) |
| Enumeration Date | 2025-07-28 |
| Last Update Date | 2025-09-10 |