| NPI | 1902630270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NC 5020947) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: NC 313786) |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2024-09-29 |