| NPI | 1750117289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 315936) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: AZ 315936) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ 315936) | |
| Enumeration Date | 2024-09-11 |
| Last Update Date | 2024-12-03 |