| NPI | 1649024381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-189138) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-189138) |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2025-09-29 |