| NPI | 1861055964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 25794) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: TN 25794) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2022-03-14 |