| NPI | 1831769710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 113715) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 79656) |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2021-07-28 |