| NPI | 1659176246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC F05250245) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: NC 314632) |
| Enumeration Date | 2025-02-17 |
| Last Update Date | 2025-05-18 |