| NPI | 1265940365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 8290) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 201119) |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2018-03-16 |