| NPI | 1487400602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 1361873) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: ID N-45980) |
| Enumeration Date | 2024-04-29 |
| Last Update Date | 2024-08-27 |