| NPI | 1891404539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 33066) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 164131) |
| Enumeration Date | 2022-11-22 |
| Last Update Date | 2023-04-07 |