| NPI | 1649856139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 10863) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 226271) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2024-05-14 |