| NPI | 1144711151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP11549) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN168621) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2018-10-08 |