| NPI | 1770594079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: TN APN6925) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: TN APN6925) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2023-03-07 |