| NPI | 1396349015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 30042) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: SC 210674) |
| Enumeration Date | 2020-11-23 |
| Last Update Date | 2025-07-17 |