| NPI | 1356726426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 6507-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 177974-30) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 6507-33) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: WI 6507-33) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WI 6507-33) | |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2020-09-11 |