| NPI | 1740308121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-083338) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ND 203699) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MS R865463) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2025-11-21 |