| NPI | 1417504887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SA2100X Clinical Nurse Specialist Acute Care (Licence: LA 203735) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 203735) |
| 363LF0000X Nurse Practitioner Family (Licence: LA 203735) | |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2024-08-18 |