| NPI | 1376569806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: MT APRN-101633) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: TN APN0000014893) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2022-09-20 |