| NPI | 1093953713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA AP04401) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN094539) |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2022-12-08 |