| NPI | 1912614348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5017396) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: NC 315093) |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2022-12-22 |