| NPI | 1639843014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-140153) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-140153) |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2021-09-17 |