| NPI | 1831446921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 4942-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 156589-30) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2021-11-18 |