| NPI | 1639567019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: ID NP-1519A) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: ID N-29354) |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: ID CNS-77A) | |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2015-01-07 |