| NPI | 1649594813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 21198) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 19560) |
| Enumeration Date | 2010-03-17 |
| Last Update Date | 2024-04-23 |