| NPI | 1427891522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5024583) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: NC 293122) |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2026-07-09 |