| NPI | 1184322646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA NP95021687) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP95021687) |
| Enumeration Date | 2023-02-23 |
| Last Update Date | 2024-08-16 |