| NPI | 1609385715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AR A005370) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: AR R093353) |
| Enumeration Date | 2017-09-21 |
| Last Update Date | 2018-09-20 |