| NPI | 1891310827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 242441) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI F06201277) |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2020-06-19 |