| NPI | 1063259646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2023041355) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2023041355) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2023041355) | |
| Enumeration Date | 2024-07-11 |
| Last Update Date | 2024-07-11 |