| NPI | 1366976987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA AG0616142) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN210284) |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2022-09-27 |