| NPI | 1619560984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK 1619560984) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OK R0094181) |
| Enumeration Date | 2021-02-17 |
| Last Update Date | 2026-05-11 |