| NPI | 1467076158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 27892) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 193226) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024180462) | |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2022-03-08 |