| NPI | 1255978417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5013138) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5013138) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000026681) | |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: TN APN0000026681) | |
| Enumeration Date | 2019-12-06 |
| Last Update Date | 2025-06-03 |