| NPI | 1730647918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AL 1-146919) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-146919) |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2019-05-02 |