| NPI | 1598527558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5019803) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 313795) |
| Enumeration Date | 2024-01-25 |
| Last Update Date | 2024-03-20 |