| NPI | 1427643337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 9662) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NM RN-85970) |
| 363LF0000X Nurse Practitioner, Family (Licence: AK 182401) | |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2022-11-07 |