| NPI | 1386352615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 13523-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 1102615-30) |
| 363L00000X Nurse Practitioner (Licence: AZ 282771) | |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2023-05-23 |