| NPI | 1023884319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95026204) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: CA 5077) |
| Enumeration Date | 2023-11-28 |
| Last Update Date | 2024-06-03 |