| NPI | 1043052665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: DC NP500002195) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD R256419) |
| Enumeration Date | 2024-06-12 |
| Last Update Date | 2024-08-20 |