| NPI | 1750743902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP033956) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN636414) |
| Enumeration Date | 2016-03-27 |
| Last Update Date | 2026-01-09 |