| NPI | 1134944788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 37981) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic |
| 163W00000X Registered Nurse (Licence: TN 259150) | |
| Enumeration Date | 2024-11-19 |
| Last Update Date | 2025-01-10 |