| NPI | 1376106922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: AL 1-153480) |
| Additional Taxonomies | 163WM0705X Registered Nurse Medical-Surgical (Licence: AL 1-153480) |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2020-09-21 |