| NPI | 1689467003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 327863) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN196998) |
| Enumeration Date | 2025-05-28 |
| Last Update Date | 2025-08-07 |