| NPI | 1578094207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 22515) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 194218) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2022-05-23 |