| NPI | 1265825392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-100374) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: AL 1-100374) |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2019-01-18 |