| NPI | 1316681976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: HI 5337) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: HI RN-84057) |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2025-08-04 |