| NPI | 1124610928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R224708) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MD R224708) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R224708) | |
| Enumeration Date | 2021-02-03 |
| Last Update Date | 2026-02-05 |