| NPI | 1053190413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OR 10018496) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: AZ RN201676) |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2024-09-30 |