| NPI | 1821475120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: WI 5933-33) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: WI 5933-33) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2020-06-16 |