| NPI | 1609338631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA 335894) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AL 1-166735) |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2025-05-15 |