| NPI | 1174007223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM CNP-03565) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: AZ RN191849) |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2023-02-27 |