| NPI | 1275065062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-126682) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: AL 1-126682) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2022-07-21 |