| NPI | 1164123956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 2019012238) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-143674) |
| Enumeration Date | 2023-03-17 |
| Last Update Date | 2023-05-18 |