| NPI | 1932947181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 36805) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 201295) |
| Enumeration Date | 2024-07-19 |
| Last Update Date | 2024-08-12 |