| NPI | 1427666460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 32564) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024179740) |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2025-04-22 |