| NPI | 1154194900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 907970) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 906485) |
| Enumeration Date | 2023-11-02 |
| Last Update Date | 2026-02-12 |