| NPI | 1174957864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 17873) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 148275) |
| Enumeration Date | 2013-08-29 |
| Last Update Date | 2023-10-31 |