| NPI | 1598335721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 3-000740) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 235114) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 30295) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AL 3-000740) | |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2024-02-01 |