| NPI | 1891455507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2021049273) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021049273) |
| Enumeration Date | 2021-12-21 |
| Last Update Date | 2024-12-19 |