| NPI | 1942003132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AR 233166) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R109320) |
| Enumeration Date | 2025-03-31 |
| Last Update Date | 2025-07-22 |