| NPI | 1740813518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2024019213) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2011021161) |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2024-07-24 |