| NPI | 1184711202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 10502) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN10502) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2012-05-24 |