| NPI | 1568338101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 340601) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: UT 13010100-3102) |
| Enumeration Date | 2025-10-13 |
| Last Update Date | 2026-06-09 |