| NPI | 1457970022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CT 8927) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 153286) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2020-09-17 |