| NPI | 1649713710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 21751) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TN 170129) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 342458) | |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2023-07-03 |