| NPI | 1386403517 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95025026) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 815700) | 
| Enumeration Date | 2024-03-18 | 
| Last Update Date | 2025-09-12 |