| NPI | 1841004363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CA 95033663) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist Adult Health (Licence: CA 4211) |
| Enumeration Date | 2025-02-04 |
| Last Update Date | 2025-02-04 |