| NPI | 1164968202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 26214) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11007120) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TN 26214) | |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2021-08-02 |