| NPI | 1316546013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN277704) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN277704) |
| Enumeration Date | 2020-10-22 |
| Last Update Date | 2025-10-15 |