| NPI | 1427814367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 28480) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 248782) |
| Enumeration Date | 2024-02-27 |
| Last Update Date | 2024-06-20 |