| NPI | 1407318231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: MS 904367) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 878688) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2021-02-01 |