| NPI | 1194201277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-185604) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 904674) |
| 363LF0000X Nurse Practitioner, Family (Licence: AL 3-000004) | |
| 363L00000X Nurse Practitioner (Licence: TN 24450) | |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2022-09-19 |