| NPI | 1538546874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR 222563) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 19870) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2023-09-13 |