| NPI | 1740612878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 904210) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 17800) |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2021-03-03 |