| NPI | 1457018657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R251638) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD R251638) |
| 363LF0000X Nurse Practitioner Family (Licence: MD R251638) | |
| Enumeration Date | 2021-11-22 |
| Last Update Date | 2021-11-22 |