| NPI | 1851812309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NE 112235) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 38769) |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2018-03-17 |