| NPI | 1780220707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 226732) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: AZ 226732) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: AZ 226732) | |
| 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: AZ 226732) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: AZ 226732) | |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2019-11-25 |