| NPI | 1023529401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 23304) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 194315) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2021-03-05 |