| NPI | 1659184273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 29900) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 29900) |
| Enumeration Date | 2025-01-28 |
| Last Update Date | 2025-07-02 |