| NPI | 1215525357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 071507-23) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 071507-23) |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2023-09-07 |