| NPI | 1760459648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AR S001121) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R065569) |
| 363L00000X Nurse Practitioner (Licence: AR S01121) | |
| 363L00000X Nurse Practitioner (Licence: AR S001121) | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2024-04-03 |