| NPI | 1023603131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 29011) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5014158) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5014158) | |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2022-07-19 |