| NPI | 1144867755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000026395) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000198904) |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2022-08-25 |