| NPI | 1720686090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 255182) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN157599) |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2021-05-30 |