| NPI | 1619200995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 3837) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 94718) |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2021-09-10 |