| NPI | 1972486389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN 231304) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 39458) |
| Enumeration Date | 2025-07-31 |
| Last Update Date | 2025-09-23 |