| NPI | 1629536263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 0000221959) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA 288331) |
| 163W00000X Registered Nurse (Licence: TN RN0000221959) | |
| Enumeration Date | 2019-03-02 |
| Last Update Date | 2026-06-27 |