| NPI | 1437315058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AK 203541) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 16381) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2025-04-07 |