| NPI | 1841694718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP7365) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA GAA-002038) |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2025-04-03 |