| NPI | 1629852900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 34973) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TN 224266) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 34793) | |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2024-04-26 |