| NPI | 1770858144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 16590) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 902234) |
| Enumeration Date | 2012-03-18 |
| Last Update Date | 2024-03-28 |