| NPI | 1194191908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: HI 1913) |
| Additional Taxonomies | 163WD0400X Registered Nurse, Diabetes Educator (Licence: HI 67486) |
| Enumeration Date | 2015-08-15 |
| Last Update Date | 2017-06-16 |