| NPI | 1194405480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 34143) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 191546) |
| Enumeration Date | 2023-07-20 |
| Last Update Date | 2023-07-20 |