| NPI | 1497328983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 31748) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95017823) |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2023-03-31 |