| NPI | 1154988921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024177998) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: VA 0001240841) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2019-08-06 |