| NPI | 1043747215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA 219236) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: GA 3036) |
| 163WE0003X Registered Nurse, Emergency (Licence: GA 219236) | |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2017-05-18 |