| NPI | 1649094988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 37649) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 274652) |
| Enumeration Date | 2024-11-13 |
| Last Update Date | 2024-12-11 |