| NPI | 1487045795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP7637) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM 73268) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: AZ AP7637) | |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2024-08-05 |