| NPI | 1902165210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 16197) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 16197) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2025-10-01 |