| NPI | 1962831305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.257341) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95000441) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2024-06-04 |