| NPI | 1912429317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 22831) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 202305) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2020-05-02 |