| NPI | 1912442401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-128181) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-128181) |
| Enumeration Date | 2016-12-20 |
| Last Update Date | 2024-02-22 |