| NPI | 1104358407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP10864) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP10864) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP10864) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: AZ AP10864) | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2018-01-29 |