NPI | 1861296808 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 38513) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: TN APN38513) |
Enumeration Date | 2025-04-01 |
Last Update Date | 2025-10-04 |