| NPI | 1720461379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 20218) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024172706) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2018-10-30 |