| NPI | 1316744790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 40100) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: TN 220263) |
| Enumeration Date | 2025-02-25 |
| Last Update Date | 2025-10-26 |