| NPI | 1770863565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 20585) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 173051) |
| 163W00000X Registered Nurse (Licence: IA 121588) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71003687A) | |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2024-03-11 |