| NPI | 1609585348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 32944) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TN 32944) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: TN 32944) | |
| Enumeration Date | 2022-11-22 |
| Last Update Date | 2022-11-22 |