| NPI | 1134651128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2023032737) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 22474) |
| 363L00000X Nurse Practitioner (Licence: TN 22474) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 22474) | |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2024-05-08 |