| NPI | 1144518879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 4537-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 158574-30) |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2024-05-02 |