| NPI | 1497169197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024177331) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: VA 0001238176) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2022-07-25 |