| NPI | 1376389429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 37509) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: GA RN294917) |
| Enumeration Date | 2024-07-08 |
| Last Update Date | 2025-01-17 |