| NPI | 1669144770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 30521) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 209143) |
| Enumeration Date | 2021-09-28 |
| Last Update Date | 2021-11-04 |