| NPI | 1285282830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AL 1-156108) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-156108) |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2021-07-08 |