| NPI | 1164766648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CA 22534) |
| Additional Taxonomies | 364SA2100X Clinical Nurse Specialist Acute Care (Licence: CA 3889) |
| Enumeration Date | 2012-11-21 |
| Last Update Date | 2023-11-27 |