| NPI | 1013022037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 1008-033) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 118952-030) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2021-11-19 |