| NPI | 1912573627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2021043558) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MO 2017038774) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2022-05-31 |