| NPI | 1417755349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 39334) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 215488) |
| Enumeration Date | 2025-03-05 |
| Last Update Date | 2025-09-02 |