| NPI | 1821776576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 343934) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: MI 4704398546) |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2026-09-11 |