| NPI | 1548631823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP8192) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ RN168943) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP8192) | |
| 363L00000X Nurse Practitioner (Licence: AZ 007509) | |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2020-09-03 |