| NPI | 1316668940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2022027787) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2017005324) |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2024-04-15 |