| NPI | 1477167179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: VA 0024179973) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: VA 0001262121) |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2021-10-15 |