| NPI | 1902257132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 21378) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 901611) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2024-02-02 |