| NPI | 1053826743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 23421) |
| Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: TN 217555) |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2022-03-31 |