| NPI | 1710257449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MO 2012035127) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 136296) |
| 163W00000X Registered Nurse (Licence: NM RN-74788) | |
| 363LF0000X Nurse Practitioner Family (Licence: NM CNP-01945) | |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2020-12-10 |