| NPI | 1225663792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 59586) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM RN-69356) |
| Enumeration Date | 2020-03-05 |
| Last Update Date | 2023-06-08 |