| NPI | 1518955699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 7894) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN7894) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2016-12-22 |