| NPI | 1013911635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 5811) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 61466) |
| 363L00000X Nurse Practitioner (Licence: TN APN0000005811) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2022-04-19 |