| NPI | 1932891330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NE 114974) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MO 2019016969) |
| Enumeration Date | 2023-05-23 |
| Last Update Date | 2023-08-25 |