| NPI | 1831530179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 5409-033) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 154404-30) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2021-12-20 |