| NPI | 1457817447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-162898) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-162898) |
| Enumeration Date | 2019-02-14 |
| Last Update Date | 2025-07-27 |