| NPI | 1720688443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 249498) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ 249498) |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2021-11-30 |