| NPI | 1639914609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2024030419) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MO 2014004753) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2025-09-19 |