| NPI | 1952947244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 26825) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: TN 26825) |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2024-08-23 |