| NPI | 1548870611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 904220) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 33768) |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2025-03-03 |