| NPI | 1558924233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 024782) |
| Additional Taxonomies | 104100000X Social Worker |
| 163W00000X Registered Nurse (Licence: FL RN9615399) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11036445) | |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2026-01-22 |