| NPI | 1194725432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 7041) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR A001321) |
| 363LF0000X Nurse Practitioner, Family (Licence: MS 810081) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2021-06-22 |