| NPI | 1649739392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 69119) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: ID 33331) |
| 163W00000X Registered Nurse (Licence: ID 50167) | |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2022-08-02 |