| NPI | 1659188530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MD R203485) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD 2024064132) |
| Enumeration Date | 2024-12-14 |
| Last Update Date | 2024-12-16 |