| NPI | 1659380715 |
|---|---|
| Doing Business As | |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 1756-033) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 116879-030) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2023-12-04 |