| NPI | 1629011358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 7172) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 104880) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2023-10-19 |