NPI | 1134834948 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN F12220590) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP001636) |
Enumeration Date | 2023-01-16 |
Last Update Date | 2025-06-30 |