| NPI | 1639895691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 33688) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000244964) |
| Enumeration Date | 2022-10-12 |
| Last Update Date | 2023-04-05 |