| NPI | 1235463985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 3919) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 128764) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2020-11-09 |