| NPI | 1306676333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: AZ 312801) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ 212125) |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2024-08-16 |