| NPI | 1235757535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN 0000176774) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 31292) |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2022-03-04 |