| NPI | 1467275487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2024049964) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2015045012) |
| Enumeration Date | 2024-11-07 |
| Last Update Date | 2024-12-27 |