| NPI | 1134808678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 34152) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 27469) |
| Enumeration Date | 2023-07-12 |
| Last Update Date | 2024-04-25 |