| NPI | 1174895981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-109778) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: AL 1-109778) |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2020-07-30 |