| NPI | 1699161323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 33660) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000202293) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2023-09-08 |