| NPI | 1972836633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 3840-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 138144) |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2024-03-20 |