| NPI | 1134747454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 0000029096) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000240506) |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2021-05-21 |