| NPI | 1770108292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 107793) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: AK 223789) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2025-08-07 |