| NPI | 1568185916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-135741) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-135741) |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2025-01-22 |