| NPI | 1841905783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: SC 27937) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 27937) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2024-06-27 |