| NPI | 1598474850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 286776) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN212664) |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2023-01-30 |