| NPI | 1841973443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A185262) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: IA 164027) |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2025-07-08 |