| NPI | 1710600226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: TN 32040) |
| Additional Taxonomies | 364SM0705X Clinical Nurse Specialist Medical-Surgical (Licence: TN 32040) |
| Enumeration Date | 2022-09-20 |
| Last Update Date | 2025-07-21 |