| NPI | 1134867351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 31795) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 230069) |
| 183700000X Pharmacy Technician (Licence: TN 57733) | |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2022-05-26 |