| NPI | 1720709967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: AZ 324649) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ 324649) |
| 163WS0200X Registered Nurse, School (Licence: AZ RN204990) | |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2026-07-07 |