| NPI | 1114635455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AL 1-171128) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-71128) |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2024-12-31 |