| NPI | 1184938201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN15059) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 0000015059) |
| 363LF0000X Nurse Practitioner, Family (Licence: MS A810365) | |
| Enumeration Date | 2010-07-30 |
| Last Update Date | 2023-07-18 |