| NPI | 1124658422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 9985-33) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: WI 167477) |
| Enumeration Date | 2020-01-25 |
| Last Update Date | 2022-07-20 |