| NPI | 1669245411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 907807) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-186474) |
| Enumeration Date | 2023-11-02 |
| Last Update Date | 2025-09-24 |