| NPI | 1265170856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 31966) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TN 205373) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2024-07-26 |