| NPI | 1356065148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 32406) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 234037) |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2022-09-27 |