| NPI | 1225730591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5021008) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 313517) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2024-11-26 |