| NPI | 1275620379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 7258) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN 7258) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 7258) | |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2024-02-19 |