| NPI | 1609390533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: LA AP09623) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9385871) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2019-11-05 |