| NPI | 1588281547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 298022) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: 5420) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 298022) | |
| 146N00000X Emergency Medical Technician, Basic (Licence: AZ E90833309) | |
| 163W00000X Registered Nurse (Licence: AZ 298022) | |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2026-03-05 |