| NPI | 1942692587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MD AC001852) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000180274) |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2019-09-25 |