| NPI | 1306365770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP10583) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: AZ AP10593) |
| Enumeration Date | 2017-09-16 |
| Last Update Date | 2023-10-03 |