| NPI | 1376115865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5014723) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 261515) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2021-09-13 |