| NPI | 1871808956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 4137) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 141783) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2022-08-29 |