| NPI | 1336669241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP10255) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP10255) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2022-10-11 |