| NPI | 1780197293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ AP11046) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TN APN0000022725) |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2024-02-06 |