| NPI | 1124696935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP023573) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA F01211220) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2021-06-16 |