| NPI | 1568196475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 287992) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9560557) |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2025-06-12 |