| NPI | 1750779088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL 9442096) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9442096) |
| Enumeration Date | 2015-01-09 |
| Last Update Date | 2022-09-03 |