| NPI | 1730570482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 111812) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NE 111812) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NE 111812) | |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2025-10-21 |