| NPI | 1639871247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 267971) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: AZ 267971) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: AZ 267971) | |
| 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: AZ 267971) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: AZ 267971) | |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2024-01-31 |