| NPI | 1205327103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 24254) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 24254) |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2018-05-29 |