| NPI | 1447832191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-152645) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-152645) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2025-04-23 |