| NPI | 1194787341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 1743-033) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 1743-033) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2019-04-11 |