| NPI | 1154868446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ RN166307) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ RN166307) |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2020-09-09 |