| NPI | 1609628718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: TN 35983) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN 35983) |
| Enumeration Date | 2024-04-02 |
| Last Update Date | 2024-05-09 |