| NPI | 1548235773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP11665) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: AZ RN109444) |
| 163WE0003X Registered Nurse, Emergency (Licence: AZ RN109444) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2018-09-26 |