| NPI | 1912467291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-166704) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-166704) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2023-12-22 |