| NPI | 1376732685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP2718) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP2718) |
| 363L00000X Nurse Practitioner (Licence: CA 95004227) | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2024-09-16 |