| NPI | 1497347314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5014072) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: NC P006418) |
| 163WF0300X Registered Nurse, Flight (Licence: NC 242594) | |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2021-05-27 |