| NPI | 1568841088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS F06230714) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 34265) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2023-07-19 |