| NPI | 1780244608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AL 1-156063) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 1-156063) |
| 363L00000X Nurse Practitioner (Licence: AL 1-156063) | |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2020-10-07 |