| NPI | 1215561238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 36793) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006327) |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2024-11-18 |