| NPI | 1821441619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN61655253) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209014492) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2025-05-08 |