| NPI | 1093116774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 19096) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 19096) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3013022) | |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2024-01-26 |