| NPI | 1508364936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 21761) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5018587) |
| 163WE0003X Registered Nurse, Emergency (Licence: SC 105160) | |
| Enumeration Date | 2018-01-31 |
| Last Update Date | 2024-12-04 |