| NPI | 1134585326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 20917) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 20917) |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2026-03-06 |