| NPI | 1215655568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A174108) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA 143754) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2023-05-03 |