| NPI | 1831507789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP5644) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP5444) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP5644) | |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2020-09-08 |