| NPI | 1881318699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: VA 0024186763) |
| Additional Taxonomies | 163WN0300X Registered Nurse Nephrology (Licence: VA 0001207279) |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2023-03-22 |