| NPI | 1164821054 |
|---|---|
| Other Name | NA NA NA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 19018) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 19018) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2025-03-05 |