| NPI | 1851310791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP7102) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN035147) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP7102) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ 267) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ 13) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2019-12-06 |