| NPI | 1043797970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 12062377) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 200830) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2024-04-26 |