| NPI | 1316729494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 115286) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 84336) |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2024-10-18 |