| NPI | 1750535381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 3706) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 135640) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2021-04-06 |