| NPI | 1770825630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 17468) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 17468) |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2019-12-10 |