| NPI | 1205117785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-RN-LIC-86986) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1078S) |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 5136301-4405) | |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2023-12-18 |