| NPI | 1346945649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 37775) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 37775) |
| 163W00000X Registered Nurse (Licence: SC 269595) | |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2026-01-20 |