| NPI | 1699881698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR A003021) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN7249) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2005012311) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2022-02-11 |