| NPI | 1477218774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 30811) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 00000000000) |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2026-03-30 |