| NPI | 1407475510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 27481) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-154246) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2022-03-16 |