| NPI | 1154148237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KS 58-83675-041) |
| Additional Taxonomies | 163WN0800X Registered Nurse, Neuroscience (Licence: MO 2017024604) |
| Enumeration Date | 2024-09-20 |
| Last Update Date | 2024-10-04 |