| NPI | 1902322126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 23476) |
| Additional Taxonomies | 163WF0300X Registered Nurse, Flight (Licence: TN 0000144271) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024175516) | |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2024-02-28 |