| NPI | 1558851485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: SC 26271) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: FL 9398452) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2022-07-12 |