| NPI | 1629830740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA NCO-000003) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN299525) |
| Enumeration Date | 2024-01-24 |
| Last Update Date | 2024-07-25 |