| NPI | 1164980728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 25366) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR A006249) |
| Enumeration Date | 2019-03-03 |
| Last Update Date | 2023-05-05 |