| NPI | 1669297594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MS 907181) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: MS 909769) |
| Enumeration Date | 2024-11-15 |
| Last Update Date | 2025-03-11 |