| NPI | 1285499699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MS 906549) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MS 906549) |
| 163W00000X Registered Nurse (Licence: MS 905601) | |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2024-02-27 |