| NPI | 1740423441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 3666-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 151683-30) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2011-08-09 |