| NPI | 1952902710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 33147) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 202199) |
| Enumeration Date | 2020-11-06 |
| Last Update Date | 2026-09-04 |