| NPI | 1881060168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 20294) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TN APN20294) |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2023-08-17 |