| NPI | 1194581439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R211834) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R211834) |
| 364S00000X Clinical Nurse Specialist (Licence: MD CS00228) | |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2024-12-27 |