| NPI | 1114498532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 24852) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024176713) |
| 363L00000X Nurse Practitioner (Licence: TN 24852) | |
| Enumeration Date | 2018-12-11 |
| Last Update Date | 2024-05-15 |