| NPI | 1881306215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 10000062) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OR 10000062) |
| Enumeration Date | 2022-12-16 |
| Last Update Date | 2025-12-16 |