| NPI | 1942078860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 15027-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 192732) |
| Enumeration Date | 2023-12-20 |
| Last Update Date | 2024-02-26 |