| NPI | 1841985934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 36683) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024186828) |
| Enumeration Date | 2023-04-06 |
| Last Update Date | 2023-04-06 |