| NPI | 1114775145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 10029069) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OR 202002653RN) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2024-07-08 |