| NPI | 1336635754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TN APN0000024912) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN0000024912) |
| 363L00000X Nurse Practitioner (Licence: TN 214241) | |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2025-10-03 |