| NPI | 1013553494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA 230131) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000201413) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 30593) | |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2023-07-25 |