| NPI | 1568122323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 30540) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 30540) |
| Enumeration Date | 2021-12-21 |
| Last Update Date | 2024-03-27 |