| NPI | 1538031570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ F11250547) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ 244567) |
| Enumeration Date | 2025-09-19 |
| Last Update Date | 2025-12-07 |