| NPI | 1548701881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 901990) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 22590) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2018-10-05 |