| NPI | 1942603170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN 19142) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 185452) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000019142) | |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2024-01-03 |