| NPI | 1972070316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R213670) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R213670) |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2024-03-11 |