| NPI | 1760159453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NE 113789) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 75867) |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2021-09-08 |