| NPI | 1235767328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: AZ 2019077598) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN182235) |
| 163WF0300X Registered Nurse Flight (Licence: AZ RN182235) | |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2022-01-07 |