| NPI | 1437661550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2019037100) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MO 2005024763) |
| 163WE0003X Registered Nurse, Emergency (Licence: MO 2005024763) | |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2019-10-14 |