| NPI | 1669037560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 226021) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: AZ RN188867) |
| 163WE0003X Registered Nurse, Emergency (Licence: AZ RN188867) | |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: AZ RN188867) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ 226021) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ 226021) | |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2020-02-17 |