| NPI | 1336760552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11043368) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PR 33193) |
| 207L00000X Anesthesiology (Licence: PR 3014) | |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2025-12-13 |