| NPI | 1043977721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM APRN-CNP69689) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: SD R040994) |
| Enumeration Date | 2021-11-17 |
| Last Update Date | 2024-01-21 |