| NPI | 1306441811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 280639) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN187730) |
| Enumeration Date | 2020-12-02 |
| Last Update Date | 2022-11-15 |