| NPI | 1013634419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: AL 1-181242) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-181242) |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2024-10-11 |