| NPI | 1649005877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5020874) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: NC 235585) |
| Enumeration Date | 2024-09-06 |
| Last Update Date | 2024-09-18 |