| NPI | 1578939583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 20281) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 192482) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2015-10-07 |