| NPI | 1033750948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 26739) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TN RN0000203660) |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2022-03-25 |