| NPI | 1225163769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS 858187) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: MS R858187) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2019-09-26 |