| NPI | 1477391233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 15491-33) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: WI 15491-33) |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2025-10-14 |