| NPI | 1295282598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VT 101.0134267) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VT 026.0128223) |
| 163W00000X Registered Nurse (Licence: MI 4704311906) | |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2019-06-11 |