| NPI | 1003549056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A170187) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IA F07220307) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2022-12-07 |