| NPI | 1407694334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5024727) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 351494) |
| Enumeration Date | 2024-07-16 |
| Last Update Date | 2026-07-31 |