| NPI | 1720392210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MT NUR-APRN-LIC-213686) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MT 39736) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2023-04-18 |