| NPI | 1609239425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 20853) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024173841) |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 24012) | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2022-12-22 |