| NPI | 1467720052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AR 124998) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AR 124998) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2026-09-08 |