| NPI | 1770954513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: MO 2008000393) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO AG1015111) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2019-02-20 |