| NPI | 1811715048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 36803) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: TN 38732) |
| 163W00000X Registered Nurse (Licence: TN 231089) | |
| Enumeration Date | 2024-09-27 |
| Last Update Date | 2024-09-27 |