| NPI | 1558880070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 8075) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 143450) |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2017-10-16 |