| NPI | 1871225789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DC NP1057075) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2020003397) |
| 163W00000X Registered Nurse (Licence: DC RN1057075) | |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2023-03-06 |