| NPI | 1811652480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: AZ 269868) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN192626) |
| 163WC0200X Registered Nurse Critical Care Medicine (Licence: AZ 12743151) | |
| Enumeration Date | 2021-11-08 |
| Last Update Date | 2022-02-03 |