| NPI | 1023218211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 12836) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 110480) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2023-06-09 |