| NPI | 1205465945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA NPF95012284) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA NOF95012284) |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2020-04-04 |