| NPI | 1588552269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5023072) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 323928) |
| Enumeration Date | 2025-06-24 |
| Last Update Date | 2025-09-21 |