| NPI | 1861841694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: MO 2016010704) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2006022015) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2016-06-13 |