| NPI | 1740414036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R123405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD r123405) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2024-10-14 |