| NPI | 1457066979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 38749) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 236352) |
| Enumeration Date | 2023-01-19 |
| Last Update Date | 2025-09-09 |