| NPI | 1164433587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024170002) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN RN00115147) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 7613) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2024-02-07 |