| NPI | 1982143426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 7511) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 7511) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2019-04-19 |