| NPI | 1508415811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2019032650) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MO p15252) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2019-10-01 |