| NPI | 1538874391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN 39434) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 39434) |
| Enumeration Date | 2023-01-17 |
| Last Update Date | 2025-10-21 |