| NPI | 1235753039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: LA 214266) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN142931) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2020-07-13 |