| NPI | 1699656181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR 227881) |
| Additional Taxonomies | 163WR0400X Registered Nurse, Rehabilitation (Licence: AR 227881) |
| Enumeration Date | 2025-09-10 |
| Last Update Date | 2026-09-10 |