| NPI | 1720545734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ TEMP232685) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MD R222068) |
| Enumeration Date | 2019-02-26 |
| Last Update Date | 2019-09-25 |