| NPI | 1184825150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN11414) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN APN11414) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2018-05-18 |