| NPI | 1891101689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-101672) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000019516) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN169896) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2024-02-19 |