| NPI | 1114449881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 22912) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN 22912) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2023-09-13 |