| NPI | 1902332653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 24273) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 20948) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2018-06-01 |