| NPI | 1477171510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-145367) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-145367) |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2020-08-20 |