| NPI | 1396256921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 23575) |
| Additional Taxonomies | 2081P0004X Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine (Licence: TN 23575) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TN 23575) | |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2023-10-03 |