| NPI | 1407327091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN0000025182) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 15872-33) |
| Enumeration Date | 2018-12-08 |
| Last Update Date | 2025-12-17 |