| NPI | 1326663410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 113249) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A159887) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2020-07-30 |