| NPI | 1710213053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 162460) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000014145) |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2023-08-09 |