| NPI | 1659819688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 35841) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2017004137) |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2024-05-20 |