| NPI | 1376390120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CT 013719) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: CT 142656) |
| Enumeration Date | 2024-05-01 |
| Last Update Date | 2024-08-21 |