| NPI | 1609011006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 13871) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 141356) |
| Enumeration Date | 2008-12-13 |
| Last Update Date | 2022-03-16 |