| NPI | 1972393130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5023828) |
| Additional Taxonomies | 163WF0300X Registered Nurse, Flight (Licence: TN 240833) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2025-05-10 |
| Last Update Date | 2026-01-22 |