| NPI | 1083496970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R226749) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R226749) |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: MD 0135203) | |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2023-10-16 |