| NPI | 1093255648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 22464) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TN 218015) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2024-09-12 |