| NPI | 1730729104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 904898) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS R882633) |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2021-09-17 |