| NPI | 1275940769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 5913) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 5913-33) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2024-08-02 |