| NPI | 1114680451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 30637) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 206938) |
| 363L00000X Nurse Practitioner (Licence: TN 30637) | |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2022-06-01 |