| NPI | 1144636119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: TN 18850) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 18850) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2025-02-18 |