| NPI | 1346608080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: AL 1-148340) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-148340) |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2022-07-28 |