| NPI | 1851637128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 234410) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: AZ RN148598) |
| Enumeration Date | 2012-12-14 |
| Last Update Date | 2024-01-11 |