| NPI | 1831847383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID 71036) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95017527) |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2022-03-14 |