| NPI | 1669034765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 25924) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 25924) |
| 208D00000X General Practice (Licence: TN 25924) | |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2025-03-05 |