| NPI | 1568478659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 21666) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MS R660531) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2020-12-21 |