| 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 | 2026-08-03 |