| NPI | 1912138124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 14519) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TN RN0000120438) |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2020-04-28 |