| NPI | 1992134357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 18077) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 18077) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2013-11-06 |