| NPI | 1184995292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AL 1-111030) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: AL 1-111030) |
| 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: FL RN9359978) | |
| Enumeration Date | 2012-01-20 |
| Last Update Date | 2021-03-04 |