| NPI | 1255447157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN8023) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 8023) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2025-02-20 |