| NPI | 1245979640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 12158-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 236493-30) |
| 363LF0000X Nurse Practitioner Family (Licence: WI 12158-33) | |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2024-10-10 |