| NPI | 1518593219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5014484) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC APN.23980APRN) |
| Enumeration Date | 2020-03-14 |
| Last Update Date | 2023-02-20 |