| NPI | 1740097401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PR 5438) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PR 83364) |
| 163WI0600X Registered Nurse, Infection Control (Licence: PR 83364) | |
| Enumeration Date | 2024-12-16 |
| Last Update Date | 2024-12-16 |