| NPI | 1073360244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95028468) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: CA 848788) |
| Enumeration Date | 2024-05-04 |
| Last Update Date | 2024-11-21 |