| NPI | 1801305586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024175680) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0024175680) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2022-08-29 |