| NPI | 1780261438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 24869) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 24869) |
| 363L00000X Nurse Practitioner (Licence: SC 24869) | |
| 163W00000X Registered Nurse (Licence: SC 99699) | |
| Enumeration Date | 2021-03-27 |
| Last Update Date | 2025-10-10 |