| NPI | 1740178946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 9391941-4405) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: UT 9391941-3102) |
| Enumeration Date | 2025-06-25 |
| Last Update Date | 2025-07-01 |