| NPI | 1780905257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TN APN15011) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN15011) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN0000015011) | |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2022-03-25 |