| NPI | 1548523012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 16736) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN APN16736) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2020-11-04 |