| NPI | 1992496426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AL 1-164363) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: TN 36395) |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2024-06-02 |