| NPI | 1598214223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI F06231343) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 219456-30) |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2025-10-28 |