| NPI | 1356818819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 29782) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95010202) |
| 363L00000X Nurse Practitioner (Licence: CA 95010202) | |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2023-08-17 |