| NPI | 1578055836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 24112) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 210522) |
| Enumeration Date | 2018-06-03 |
| Last Update Date | 2018-06-03 |