| NPI | 1558872531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 25267) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5009977) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 5452) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 63TT40) | |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2022-11-08 |