| NPI | 1255067898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5017459) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: M0956578) |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2023-02-12 |