| NPI | 1043821572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 28530) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 207508) |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2020-11-09 |