| NPI | 1740522457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2016001347) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2011003752) |
| 163WE0003X Registered Nurse, Emergency (Licence: MO 2011003752) | |
| 363LC1500X Nurse Practitioner, Community Health (Licence: MO 2016001347) | |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: MO 2016001347) | |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2021-06-14 |