| NPI | 1528540812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 24887) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TN 168920) |
| Enumeration Date | 2018-09-03 |
| Last Update Date | 2024-04-03 |