| NPI | 1760882690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AL 1-090988) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-090988) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL 1-090988) | |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2015-01-27 |