| NPI | 1134450307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR A005873) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000014593) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: AR A005873) | |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2021-05-04 |