| NPI | 1356988604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: UT 7643463-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 7643463-3102) |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2020-04-17 |