| NPI | 1871554170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 349887) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 349887) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2020-11-09 |