| NPI | 1174894612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: WI 4749-33) |
| Additional Taxonomies | 364SA2100X Clinical Nurse Specialist Acute Care (Licence: WI 4749-33) |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2022-07-21 |