| NPI | 1508517251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 13361-33) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: WI 224199-30) |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2022-11-30 |