| NPI | 1588333116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 29809) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 212586) |
| 363LF0000X Nurse Practitioner Family (Licence: NC 5017472) | |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2023-01-25 |