| NPI | 1659719979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AK 125179) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: FL 9279572) |
| 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: AK 30188) | |
| 363L00000X Nurse Practitioner (Licence: FL APRN9279572) | |
| Enumeration Date | 2013-06-08 |
| Last Update Date | 2021-12-28 |