| NPI | 1386350387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 33277) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 231716) |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2023-01-30 |