| NPI | 1790276608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: AZ AP11322) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AZ AP11311) |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2024-07-22 |