| NPI | 1942942024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: MO 2014038852) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: MO 2014038852) |
| Enumeration Date | 2022-04-10 |
| Last Update Date | 2023-01-03 |