| NPI | 1285317354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 14448-33) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: WI 246935-30) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2023-08-24 |