| NPI | 1063160489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 31565) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 217742) |
| 207P00000X Emergency Medicine (Licence: TN 31565) | |
| 207Q00000X Family Medicine (Licence: TN 31565) | |
| 207R00000X Internal Medicine (Licence: TN 31565) | |
| 208000000X Pediatrics (Licence: TN 31565) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: TN 31565) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TN 31565) | |
| 208600000X Surgery (Licence: TN 31565) | |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2024-06-20 |