| NPI | 1174336440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 275746) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: AZ 275746) |
| Enumeration Date | 2025-01-29 |
| Last Update Date | 2025-09-12 |