| NPI | 1508918236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID NP-534A) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: ID NP534A) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-09-01 |