| NPI | 1548733934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5011513) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NC 287100) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 287100) | |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2022-02-10 |