| NPI | 1962914663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse General Practice (Licence: TX 837227) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: TX 837227) |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2023-08-23 |