| NPI | 1568159275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AL 1-184925) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-184925) |
| Enumeration Date | 2023-04-21 |
| Last Update Date | 2025-08-27 |