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 |