| NPI | 1235762527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WI 9981-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN199380) |
| Enumeration Date | 2020-02-15 |
| Last Update Date | 2020-08-20 |