| NPI | 1184825150 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN11414) | 
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN APN11414) | 
| Enumeration Date | 2007-05-29 | 
| Last Update Date | 2025-06-09 |