| NPI | 1760114946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 31905) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: TN 3190589) |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2022-08-12 |