| NPI | 1639967490 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 323282) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ RN209649) | 
| Enumeration Date | 2025-04-30 | 
| Last Update Date | 2025-05-07 |