| NPI | 1710497136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MO 2011021523) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: MO 2017036478) |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2022-10-04 |