| NPI | 1720716152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 32211) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 32211) |
| Enumeration Date | 2022-08-12 |
| Last Update Date | 2024-08-29 |