| NPI | 1538528336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 7154) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 197924) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2026-06-15 |