| NPI | 1750087318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-102286) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: AL 1102286) |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2024-08-27 |