| NPI | 1093036725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-116752) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: GA RN176292) |
| 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: AL 1-116752) | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2020-06-04 |