| NPI | 1861108029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: AL 1-156308) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-156308) |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2024-02-28 |