| NPI | 1326488420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A119919) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: IA PS-01-100-01) |
| 363LF0000X Nurse Practitioner, Family (Licence: IA A119919) | |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2023-05-01 |