| NPI | 1659048460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 29580) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 29580) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3016346) | |
| Enumeration Date | 2021-08-28 |
| Last Update Date | 2022-07-19 |