| NPI | 1093725673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 12115) |
| Additional Taxonomies | 364SM0705X Clinical Nurse Specialist, Medical-Surgical (Licence: TN 12115) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2025-07-22 |