| NPI | 1841001914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CT 14372) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 140542) |
| Enumeration Date | 2025-01-16 |
| Last Update Date | 2025-04-30 |