| NPI | 1730907569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 237563) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA 237563) |
| Enumeration Date | 2024-10-01 |
| Last Update Date | 2025-03-04 |