| NPI | 1447140157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 39103) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95036327) |
| Enumeration Date | 2025-07-04 |
| Last Update Date | 2025-10-30 |