| NPI | 1588060792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NC YORK-0FBA8) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: WV 57522) |
| Enumeration Date | 2014-11-15 |
| Last Update Date | 2025-06-14 |