| NPI | 1942531553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: TN 14764) |
| Additional Taxonomies | 163WX0800X Registered Nurse Orthopedic (Licence: TN RN0000167750) |
| Enumeration Date | 2010-01-21 |
| Last Update Date | 2016-06-01 |