| NPI | 1376292003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 35553) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 220465) |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2024-01-25 |