| NPI | 1295302024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5014542) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: NC 225068) |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2021-07-12 |