| NPI | 1194289298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 26463) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11001099) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: TN 26463) | |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2024-03-07 |