| NPI | 1972215846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 287084) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: AZ RN179489) |
| Enumeration Date | 2022-12-22 |
| Last Update Date | 2023-02-14 |