| NPI | 1134116205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 7743) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN RN118564) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2023-09-27 |