| NPI | 1003326836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 36205) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN210886) |
| 183700000X Pharmacy Technician (Licence: TN 60924) | |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2024-10-30 |