| NPI | 1366907602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: AZ AP11735) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN165012) |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2022-10-27 |