| NPI | 1568259182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AR 216407) |
| Additional Taxonomies | 363LS0200X Nurse Practitioner, School (Licence: OK 00) |
| Enumeration Date | 2025-04-24 |
| Last Update Date | 2025-04-24 |