| NPI | 1104228527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 19129) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: TN 19129) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2024-08-05 |