| NPI | 1629788336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA 2024089462) |
| Additional Taxonomies | 163WH0500X Registered Nurse, Hemodialysis (Licence: GA RN280762) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2025-11-03 |