| NPI | 1972025179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: TN 22919) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 191357) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2021-06-09 |