| NPI | 1780242412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5012957) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 23487) |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: GA RN264549) | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2026-04-13 |