| NPI | 1336478445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 3609) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: WI 3909) |
| Enumeration Date | 2009-12-18 |
| Last Update Date | 2018-02-16 |