| NPI | 1629647748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: SC 257761) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5021386) |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2025-03-24 |