| NPI | 1851336036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 12107) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN APN0000012107) |
| 163W00000X Registered Nurse (Licence: TN RN0000132474) | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2025-12-12 |