| NPI | 1942099502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 15260) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 86136) |
| Enumeration Date | 2025-05-01 |
| Last Update Date | 2025-08-21 |