| NPI | 1073251989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: ID 74159) |
| Additional Taxonomies | 163WM0705X Registered Nurse Medical-Surgical (Licence: MD R201680) |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2023-12-08 |