| NPI | 1134990674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 13760498-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 266108) |
| Enumeration Date | 2024-01-12 |
| Last Update Date | 2024-12-10 |