| NPI | 1962991620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 8516-33) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: WI 139682-30) |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2018-09-13 |