| NPI | 1588479984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 318364) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NV 885536) |
| Enumeration Date | 2025-02-11 |
| Last Update Date | 2025-02-19 |