| NPI | 1225367402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 169893) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 9139) |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2019-05-30 |