| NPI | 1861453656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AR R049312) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AR A01459 ANP) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2024-06-22 |