| NPI | 1942536362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11014552) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 14461) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2023-05-29 |