| NPI | 1710538244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA H158402) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9518328) |
| 163W00000X Registered Nurse (Licence: IA 128064) | |
| 363L00000X Nurse Practitioner (Licence: FL 11004919) | |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2025-03-07 |