| NPI | 1184269565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 26824) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 194453) |
| Enumeration Date | 2019-11-09 |
| Last Update Date | 2023-05-08 |