| NPI | 1942780382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 812736) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID 57640) |
| 363L00000X Nurse Practitioner (Licence: CT 008028) | |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2019-02-01 |