| NPI | 1053407858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 140141) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 140141) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-03-05 |