| NPI | 1780066266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 19584) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 181300) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2023-09-26 |