| NPI | 1689139669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA G153862) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 76033) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2019-02-19 |