| NPI | 1912311838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN18684) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN165538) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2022-04-05 |