| NPI | 1477358059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95160816) |
| Additional Taxonomies | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: CA 95160816) |
| Enumeration Date | 2025-02-17 |
| Last Update Date | 2025-02-17 |