| NPI | 1437558061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS F0115273) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MS R874310) |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2021-11-09 |