| NPI | 1104438928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CA 95014576) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 836400) |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2021-05-19 |