| NPI | 1275277592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 31712) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9263104) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL F04220337) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11019432) | |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2022-07-02 |