| NPI | 1295104305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 7899) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 19857) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2022-07-21 |