| NPI | 1235757436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 29914) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 220175) |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2023-10-13 |