| NPI | 1487117461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5012759) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 171504) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2020-10-26 |