| NPI | 1518593847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OR 201908535NP-PP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: CA 95014504) |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2021-04-08 |