| NPI | 1639639743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AL 1-150166) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-150166) |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: AL 1-150166) | |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2022-01-11 |