| NPI | 1922763903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 32008) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-169614) |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2022-10-25 |