| NPI | 1104562701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95029925) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95165644) |
| Enumeration Date | 2022-05-07 |
| Last Update Date | 2024-05-30 |