| NPI | 1396359899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 28125) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 28125) |
| 163WF0300X Registered Nurse, Flight (Licence: TN 230101) | |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2023-08-09 |