| NPI | 1265180830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 11029158) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9462182) |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2024-02-16 |