| NPI | 1487951042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 19975) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 890929) |
| Enumeration Date | 2011-02-17 |
| Last Update Date | 2023-10-25 |