| NPI | 1669605093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024194218) |
| Additional Taxonomies | 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: VA 0024194218) |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2025-08-11 |