| NPI | 1679628697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS 901999) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS R852829) |
| 163WE0003X Registered Nurse, Emergency (Licence: MS R852829) | |
| 163WF0300X Registered Nurse, Flight (Licence: MS R852829) | |
| 163WU0100X Registered Nurse, Urology (Licence: MS R852829) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2021-05-27 |